Cuba has become the first country to receive official validation from the World Health Organization that it has eliminated mother-to-child transmission of HIV and syphilis – an achievement that officials credit to a long-standing tradition of universal health care coverage and access in the island nation.
“This historic achievement was made possible by a health system that provides equitable, integrated health services based on primary health care that include difficult and complex interventions like those required for prevention of mother-to-child transmission of HIV and syphilis,” Dr. Carissa F. Etienne, director of the Pan American Health Organization (PAHO), WHO’s Regional Office of the Americas, said during a press briefing.
Cuba’s success demonstrates that universal access and universal health coverage are feasible and are, indeed, the key to success, even against challenges as daunting as HIV, she added.
Several other countries are also poised to request validation of the elimination of vertical HIV and syphilis transmission – defined as fewer than two cases of HIV in every 100 babies born to women with HIV and fewer than one case of syphilis for every 2,000 live births, according to Dr. Etienne.
Even some larger countries – including the United States and Canada – may have also achieved elimination of vertical transmission of HIV and syphilis, but they have not requested validation yet, she said.
The validation process is rigorous and requires a visit by an international panel of experts convened by PAHO/WHO; in Cuba, the panel spent several days visiting health centers, laboratories, and government offices, and also interviewed health officials and other key players, paying particular attention to human rights issues.
Validation requires that impact indicators (such as achieving fewer than 50 cases of new pediatric infections caused by mother-to-child transmissions per 100,000 live births and an HIV transmission rate of less than 5% in breastfeeding populations and less than 2% in non–breastfeeding populations) be met for at least a year. Additionally, process indicators, (95% of pregnant women receiving an antenatal visit, knowing their HIV status and/or being tested for syphilis, and receiving appropriate treatment) must be met for at least 2 years.
Cuba, which has been part of a regional initiative led by PAHO and WHO to eliminate vertical transmission of HIV and syphilis, achieved its goal by ensuring early access to prenatal care, HIV and syphilis testing for pregnant women and their partners, treatment for those who test positive and their babies, substitution of breastfeeding among those affected, and prevention of HIV and syphilis before and during pregnancy through promotion of condoms use and other measures.
Cuba, and any country that receives validation of elimination must maintain ongoing programs to ensure continued success.
Every year, an estimated 1.4 million women living with HIV become pregnant. If untreated, they have a 15%-45% chance of transmitting the virus to their children during pregnancy, labor, delivery, or breast-feeding. That risk drops to just over 1% if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur, according to PAHO/WHO, which noted in a press release that the number of children born annually with HIV has almost halved since 2009 – down from 400,000 to 240,000 in 2013.
However, stepped-up efforts will be needed to reach the global target of less than 40,000 new child infections per year.
“To achieve that, we need a final push to ensure that all pregnant women have access to sexual and reproductive health services that include HIV and syphilis testing and antiretroviral and penicillin treatment,” Dr. Etienne said. “Treatment is essential to save women’s lives, to clear maternal syphilis, and to reduce the chances that mothers will transmit these infections to their babies.”
